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Thursday, April 30, 2009

The MenEngage Symposium in Rio, as well as EngenderHealth, were highlighted in a new article from IRIN, the news and analysis service of the UN Office for the Coordination of Humanitarian Affairs:

"Men don't cry. Men take risks. Men don't ask for help. Men are strong. Men have many sexual partners. These stereotypes of masculinity are contributing to the spread of HIV throughout the world, experts warned at a recent symposium on men and boys."

Our vice president of programs, Dr. Isaiah Ndong, was a recent guest writer for the Guardian:

"The greater number of truck drivers that will use the new road through Katine could pose increased risks of sexually transmitted infections in the area. It is vital drivers are encouraged to lead healthy lifestyles, argues Isaiah Ndong, from the charity EngenderHealth."

Saturday, April 4, 2009

On the surface, there was a great deal of academic talk about “patriarchal masculinities” and the “masculinity of hegemony” at the “Men, Masculinities, Globalization, Development and Social Justice” session today (April 4). But for me it was another opportunity to think about the ways in which stereotypes are created and perpetuated in our daily lives.

One speaker, Juan Guillermo Figueroa from Colegio de Mexico, likened the way we socialize men through sports and competition as the “gym academy.” Men are allowed to hug and kiss each other on the field, but are discouraged to display any emotion outside of this sports context. This example highlights the importance of building spaces for men and communities to address such gender norms.

The MAP program has several strategies in place that tackle these deep-rooted behaviors and advance the global movement for social justice by empowering both men and women. We need to build on such successful programs. With more than 450 people, representing 80 countries, the Rio call for action commands a unified voice to help us move forward in our work and remain mindful. The possibility for change is very much in our hands.

Friday, April 3, 2009

Throughout the day, the one salient theme echoed by many of the presenters was the concept of privilege—reminding me that it is impossible to talk about gender without referencing power and who holds it.

For those of us who develop gender programs, we must be aware of the social, political, and economic dynamics that exist within a community. Several research documents explore these complicated dynamics and we should rely upon them to inform our work.

In the session “Gender and Masculinities in Post-Conflict Settings,” presenters described the extreme violence that young men and boys experience daily in the most poverty- stricken areas. The stories they told were overwhelming. While the research presented was moving, informative, and demonstrated the great demand for targeted services, there was no guidance given for implementing programs focused on men and boys in these settings.

Traditionally, there has been a dearth of guiding documents in this area. However, recently MAP has made great efforts to address these issues, through its work to engage men and boys in post-conflict and emergency settings.

Our curriculum provides a space for health and social service providers to discuss and plan for these different circumstances, considering the cultural, social, and political contexts that impact gender-based violence and the HIV epidemic.

This session has made me more hopeful that in the future we can share our best practices and come up with effective strategies to help this community of young men and boys.

On day four of the conference, the workshop that clearly stood out for me was, “Gender and Masculinity in Post-Conflict Settings.” In it, we examined experiences of men in war-torn societies, including post-genocide Rwanda, northern Uganda and eastern Congo, East Timor and Gaza.

One speaker used an interesting phrase, “gender against men,” to describe how strict notions of manhood are a liability to those men who fall outside of the limits it sets, men who don’t live up to the expectations inherent in “being a man.”

In post-conflict settings, such men might include those who have been the victims of sexual violence. The speaker from Uganda showed a moving video documenting the experience of one Congolese man (his identity was protected) who candidly described the horror of being held prisoner by the forces fighting in eastern Congo: Over a period of days, he was repeatedly gang-raped by soldiers. Though the physical trauma was beyond daunting, this man also knew that his perpetrators’ intention was to humiliate him, to diminish him, to demonstrate their power over him by putting him “in his place”—as a “woman.”

This sounded disturbingly familiar. We know that, ultimately, rape is about power, even when both the perpetrator and victim are men. As an anthropologist, I also found it fascinating how gender definitions are used to make sense of those who have power and those who don’t. It’s not merely academic - it plays out daily in the most devastating ways: In these and other post-conflict settings, men who aren’t willing to fight—to take up that traditionally “male” role –are feminized and subject to the same reign of terrors as women.

Unfortunately, the humiliation of male victims of sexual violence is further compounded when they seek counseling and care. The limited systems available (in this case United Nations missions) to support survivors of rape are closed to men. Indeed, support workers’ own definition of rape has excluded men as possible victims, and even those who did “get it” conceded that, “We have programs for women at-risk and for those who traumatized by sexual violence, but we have nothing for men.”

The same speaker explained that this is in part a result of what he called “patriarchal feminism” – a one-sided concept wherein only women are vulnerable. He went on to say that this is quite damaging for women, too, because it limits them to the role of victims rather than as agents of change. He seemed to be saying that many efforts to promote women’s equality actually reinforce traditional visions of womanhood and manhood (thus the “patriarchy”).

I agree with the speaker that, inadvertently, some “empowerment” efforts may reinforce rather than change norms. But the term “patriarchal feminism” sounds like plain old patriarchy to me, because there is no doubt that pervasive and age-old ideals of what women and men should be and do really DO oppress women! Yet this workshop made clear that we all need to be more conscientious of and concerned by how the meanings of “manhood” affect men, too. Clearly, they continue to benefit men in power, but they render other men even more vulnerable and sometimes invisible—and in the worst cases, beyond the safety net of services and support.

Thursday, April 2, 2009

One of the recurring themes at global symposium is the resistance to male involvement in reproductive and sexual health services that we’ve encountered around the world—resistance among individuals, in communities, and from governments. And it occurred to me yet again that this resistance may be due to simple lack of imagination: When people haven’t “seen” male involvement in practice, it’s hard to fathom what programs for men could look like. What resources are required to get men involved? What expertise is needed to start effective programs? And how would such programs affect current efforts that aim to improve women’s health and lives?

On Wednesday, I attended a training session on “Engaging Men and Boys in Clinic and Social Service Settings” in which we examined the nuts and bolts of programming and started to answer some of these questions.

The training, conducted in part by EngenderHealth’s own Manisha Mehta, started with a great activity where we were each put “in charge” of providing a health service focused on either men, or on couples, and asked to think about what our client, or clients, might need: Would it be counseling, clinical care (such as testing or treatment), health education, or would broader social marketing efforts be best? It got the room thinking about what we can easily offer from means within our reach.

My assignment was: “You are a nurse speaking with a couple in which one person is living with HIV, and the other does not have HIV. They want to know about their options for avoiding pregnancy and transmitting HIV.” (I decided this couple would need both health education and counseling—perhaps slightly more counseling.)

This activity led to enthusiastic conversations and demonstrated a diversity of what male involvement programming can look like, the huge range of services that are possible, that many services can be offered at low or no cost, and—perhaps best of all—that they actually could be integrated alongside existing services for women. In fact, there was a consensus that for reasons of ethics, equity, and sustainability, an integrated approach (rather than offering separate men’s services) really makes the most sense in settings like Tanzania, where there are is already a shortage of health services.

Next, we were divided into groups and given a case study. My group examined why young people in general—those between the ages of 15 and 24—and young men in particular are reluctant to use health services, even when they are designed to be “youth-friendly.”

We also had a larger discussion of why men are reluctant to use services ostensibly designed for them—so-called “male-friendly” services. We cited many reasons, but ultimately it seems like it’s a vicious cycle: Men don’t seek services, so health clinics become geared towards women, which means that they become “women’s” places, and then men won’t go to get care because clinics are “for women.” There’s also the reality that many health clinics aren’t open during hours that men have time to go.

I was lucky that my group included a senior member from Tanzania’s Ministry of Health. We talked very concretely about how CHAMPION and the Ministry could collaborate to provide male- and couple-friendly services. It was so encouraging to see the Ministry representative’s enthusiasm for integrating services—everything from prostrate cancer screenings, to counseling for sexual anxiety and dysfunction, to better vasectomy services, and improved treatment for sexually transmitted infections—as a start!

As importantly, we discussed how we might offer counseling to men—in a site outside of a clinic—that can help them examine and start to change behaviors (like having multiple sexual partners at the same time) that make them more likely to spread HIV.

This conversation cemented a key point of the training workshop: Male-friendly services cannot exist in a vacuum. Instead, they need to be an integral part of a continuum of care for whole families. This is what will make a difference in the lives of men, women and children.

We're happy to announce the launch of the Maternal Health Task Force web site! In the words of Ann K. Blanc, the project's director...

I’m happy to let you know that the Maternal Health Task Force is now officially on-line! We launched our website late yesterday at www.maternalhealthtaskforce.org. You’ll note that it’s a very simple site at this stage – we will be expanding its capacity and extending its reach significantly as the information systems and knowledge management strategies for the project take shape. Stay tuned… much more to come!

It is primarily a blog at this point, but will be growing in the near future.

The Kerry-Lugar amendment just passed in the Senate by unanimous consent! Thank you to everyone who sent your Senators a letter supporting the Kerry-Lugar Amendment. Our collective efforts paid off.

With your help, we can continue to make sure our leaders stay committed to global health. If you have not already done so, please join our 3FOR1 campaign at http://www.3FOR1.org in support of international family planning—watch the video, send the letter to President Obama, and spread the word. Thank you!

Wednesday, April 1, 2009

This afternoon I attended a workshop addressing homophobia and discrimination. It wasn’t at all what I expected. Instead, I found myself thinking in new ways about the implications of the rigid definitions and expectations of “male” and “female.”

I learned that in some places in South Asia, you’re considered gay only if you are the “receiver” in a sexual relationship with another man. If you are not the “receiver” (how would anyone ever find out?!) you’ll never be thought of as gay—even if you have no interest in ever having a sexual relationship with a woman!

In Namibia, where I live and work, some people look at a man who is gay and think that actually he wants to be a woman. It’s the easiest way for them to make sense of it, even though it really makes no sense at all.

This got me thinking about my work with young men and young women and how, on the one hand, we are always trying to do a better job of including people who identify themselves as lesbian, gay, and transgendered. Yet on the other hand, our work is about helping people—all people—express themselves in healthy ways, to give them the strength to never engage in behaviors that would ever cause harm to another, and that they also the skills to protect themselves if needed. If you talk to all men about their sexual health, does it really matter what kind of sex they’re having?

Today, breakout sessions offered a chance to really explore importance of inclusion, which basically means making programs as inclusive of minority populations as possible. This means including indigenous populations, migrants, refugees, the transgendered, commercial sex workers, and other marginalized groups. Usually, these groups are left out of conversations about improving health, improving communities, and creating a better life for everyone.

In our MAP work, we are aware of these vulnerable populations and include them in our outreach. One example is our new MARPs work in Ethiopia which directs HIV prevention efforts to the most at- risk, yet hard-to-reach, populations, including commercial sex workers. Achieving a gender-equitable world means that all people can enjoy human rights, including the right to health care. Moving forward, we need to continue expanding our reach so that as men become partners in the global call for gender equality, these groups remain an integral part of the conversation.

The morning of day two I viewed the Symposium’s photo exhibit entitled, “The World’s Most Influential Men,” which highlights positive male role models for boys (and girls, too!) from 20 countries. Even more than the photos, I was moved by the accompanying captions. In particular, a beautiful portrait of a father and son from Ethiopia was tagged with the quote, “To the world you may be one person, but to one person you may be the world.”

Another photo was a powerful reminder that men’s roles are not limited to fatherhood but span the entire community—from brothers and uncles, to teachers, coaches, to local government leaders: One man’s beliefs and acts really do impact an extended network of people.

At CHAMPION, we had a similar idea. Our formative research revealed that most Tanzanians thought that gender equitable men did not exist. We thought it was critical to show that they did exist, that all over Tanzania there are men working for the health of their families and communities. We created a photo and story calendar of male “champions” from around the nation, and mounted an exhibit at our recent project launch.

The most provocative session of the day for me was the “Dialogue with Women’s Rights Movements,” which began with personal reflections by the speakers about how they came to their work (how have all of us ended up in this room together?) and later turned to recent press coverage of a disturbing trend in Brazil: the high incidence of rape and molestation of young girls and women. Where is the public outrage from men? they asked. There are gender-equitable men in all of our communities, and among our leaders. But where is their leadership at times like this? Where are their voices?

The photos and speakers in this and other sessions affirmed the importance of gender-equitable men speaking out – of our need to both see and hear them: Men who truly believe in the possibility of a transformed world have a responsibility to be visible, and to challenge other men’s sexist and damaging behaviors.